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Mechanism for Introducing Expanded Clinical Procedures Into Midwifery Practice

Midwifery practice is responsive to the needs of the client, the needs of the community, the growing body of literature and scientific evidence relating to midwifery practice, and the midwife's desire to continually improve care to women and their families. While the Midwives' Association of Washington State does not approve or disapprove the incorporation of new clinical procedures into midwifery practice, the following mechanism has been developed to assist the midwife, and her peer community, in making a decision regarding expanding clinical practice. Any expanded practice should fall within scope of practice limitations as outlined in law.

In order to introduce expanded clinical procedures into practice, midwives shall create a written portfolio to include the following:

  • Description of proposed procedure and a protocol that would guide practice.
  • Needs assessment analysis identifying the need for this specific expanded procedure, including consumer demand, availability or lack of appropriate services elsewhere, safety considerations, availability and interest of qualified midwives.
  • Bibliography of relevant midwifery and medical literature, statute, and professional documents that would constrain or support the incorporation of the procedure.
  • Outline of specific provider training and experience qualifying the midwife to use the expanded procedure, including a plan for maintaining competency.
  • Documentation of recommendations or opinions made by a consulting physician(s) regarding expanded procedure and how the midwife has addressed those recommendations.
  • Written client informed choice document to be signed by the client detailing a discussion that includes risks and benefits of both the new practice and its alternatives, and pertinent information from the midwifery and medical literature.
  • Plan for data collection and outcome evaluation regarding procedure utilization and outcomes, client and provider satisfaction, and an annual recommendation for continuation, modification or termination of expanded clinical practice.
  • Plan for timely peer review of any adverse outcomes. Midwife to provide case presentation and portfolio when submitting a case for review.

A copy of this portfolio shall be archived with the MAWS secretary and made available, with the midwife's permission, as a resource to other MAWS members.